Healthcare Provider Details

I. General information

NPI: 1356277214
Provider Name (Legal Business Name): AMANDA LE GRANT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 WATKINS MILL RD
GAITHERSBURG MD
20879-3301
US

IV. Provider business mailing address

655 WATKINS MILL RD
GAITHERSBURG MD
20879-3301
US

V. Phone/Fax

Practice location:
  • Phone: 240-632-4150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202223575
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30900
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: